ERs face serious imbalance: research

Taiwan's emergency rooms (ER) face a serious imbalance between the number of doctors and patients, with the former keen to leave their jobs while the latter tend to abuse medical services, a research noted yesterday.

ER doctors have the highest departure rate compared to physicians from other departments after 10 years of service, according to a report presented to an annual meeting of the Taiwan Society of Emergency Medicine (TSEM).

Li Yi-kung, the director of the ER at the Tzu Chi hospital in Dalin who wrote the report, said doctors may gain a lot of experience after spending 10 years in ERs, but they also start to lose their stamina too.

Ten years ago, ERs in Taiwan treated about 3.2 million patients annually, but last year the number almost doubled to 6.5 million, said Tsai Wei-mou, head of the TSEM.

Many factors contribute to the problems of Taiwan's ERs, such as work pressure, low wages, rising risks of medical disputes, patients' abuse of services, and the payment scheme of the National Health Insurance (NHI) program, said the TSEM.

Many ER doctors have left for less stressful work, such as cosmetic surgery, or for other countries, such as China, said Lu Li-hua, director of the ER of a general hospital in Taichung.

China has been eager to recruit ER doctors from Taiwan, Lu said. Although wages may be similar, China offers better benefits, he added.

Fees for the emergency services are so low — only NT$200 more than services for outpatients — that people tend to see the ER as a place to receive express care of ailments that could be treated in outpatient departments, said Chen Po-chang, director of the ER at Chang Gung Memorial Hospital in Linkou.

When registrations for an outpatient department are full for the day, many patients simply turn to the ER for treatment, Chen said.

Some patients simply have no time to see doctors during the day; therefore, they choose to visit the ER at night, he said.

Many health insurance policies are also to be blamed, as they allow people who stay at an ER for six or more hours to claim compensations regardless of their medical conditions, the TSEM said.

Some policies even offer extra compensation if the patient is sent to the ER by ambulance, which encourages patients to use ambulances as taxis, TSEM said.

Chen noted that ambulance services or ERs seldom reject patients for fear that it could later lead to legal disputes.

One solution to the problem is to raise ER fees and to readjust NHI's payment for emergency services, Chen suggested.